BACKGROUND: The clinical value of super-extended lymph node dissection (D2(+) ) is still debated. This procedure has not been reported using the laparoscopic or robotic approach. Although this technique, in low-volume centres, could lead to an increased risk of morbidity, in high-volume centres morbidity and mortality are similar to those of the standard D2 lymphadenectomy. Robotic surgery could overcome the limitations of laparoscopic surgery, especially in the removal of posterior nodal stations...

PURPOSE: The incidence of adenocarcinoma of the esophagogastric junction is increasing, but laparoscopic proximal gastrectomy is not widely accepted due to the absence of a standardized technique of reconstruction. This report describes a novel technique of esophagogastric tube reconstruction in laparoscopic proximal gastrectomy for Siewert type II tumors. METHODS: Laparoscopic proximal gastrectomy, sometimes with transhiatal distal esophagectomy, was performed...

Both locally advanced adenocarcinoma of the stomach and gastro-esophageal junction are associated with poor prognosis due to the lack of effective treatment. Recently multimodal treatment consisting of neoadjuvant chemotherapy in combination with radiotherapy is reported to improve survival when compared to surgery alone. Neoadjuvant therapy in these locally advanced tumors allows for early tumor responses and the extent of tumor regression that can be achieved is considered a significant prognostic factor...

BACKGROUND: Open transthoracic oesophagectomy is the standard treatment for infracarinal resectable oesophageal carcinomas, although it is associated with high mortality and morbidity rates of 2 to 10% and 30 to 50%, respectively, for both the abdominal and thoracic approaches. The worldwide popularity of laparoscopic techniques is based on promising results, including lower postoperative morbidity rates, which are related to the reduced postoperative trauma. We hypothesise that the laparoscopic abdominal approach (laparoscopic gastric mobilisation) in oesophageal cancer surgery will decrease the major postoperative complication rate due to the reduced surgical trauma...

BACKGROUND: "Conventional multiport" laparoscopic gastrectomy for early stage gastric cancer is an increasingly frequently performed procedure. The authors describe their experience of the first reported single-port laparoscopic subtotal gastrectomy in an 88-year-old lady with early antral gastric adenocarcinoma. METHOD: Single-port laparoscopic subtotal gastrectomy with D1α lymphadenectomy was successfully performed using a transumbilical multichannel single port...

BACKGROUND: Treatment of gastric cancer is more and more becoming an individualized decision. The choice of the optimal approach is based on prognostic factors, on the anatomic site of the tumor, and on expectations about the response to neoadjuvant treatment. Early gastric cancer that is limited to the mucosal layer is the domain of endoscopic resections. As soon as the submucosal layer is invaded, surgical strategies with adequate lymphadenectomy become necessary. DISCUSSION: In many East Asian Centers and some other centers in the world, these tumors are resected by a laparoscopic approach...

Bone morphogenetic protein-2 (BMP-2) was reported to enhance migration, invasion, and metastasis at the various types of cancer cells. The purpose of this study is to identify the role of BMP-2 in progression of gastric cancer. Forty-four patients with operable gastric cancer were enrolled. Also, twenty healthy volunteers were enrolled as control group. All patients received gastrectomy with D2 lymphadenectomy, and surgical staging was performed. Whole blood was obtained preoperatively in all patients, and serum BMP-2 levels were quantified by commercially available ELISA kit...

Surgery represents today the standard treatment of oesophageal and gastric cancer. Associated morbidity remain however significant in term of incisional access and functional sequels after organ resection and extended lymphadenectomy. Retrospective reviews of surgical series have defined indications for which more conservative treatment appears to provide similar survival without the need for lymph node resection. Endoscopic resection is now accepted for the treatment of well-differentiated tumors restricted to the mucosa...

BACKGROUND: Transthoracic esophagectomy with extended lymph node dissection is associated with higher morbidity rates than transhiatal esophagectomy. This morbidity rate could be reduced by the use of minimally invasive techniques. The feasibility of robot-assisted thoracoscopic esophagectomy (RTE) with mediastinal lymphadenectomy was assessed prospectively. METHODS: This study investigated 21 consecutive patients with esophageal cancer who underwent RTE using the Da Vinci robotic system...

Adenocarcinoma of the esophagus and gastroesophageal junction (GEJ) has shown a remarkable increase during recent decades. Most patients are present with advanced stage disease, reflecting transmural growth and metastasis to lymph nodes at the time of diagnosis. Moreover, the pattern of lymph node dissemination is chaotic and difficult to predict, and despite the use of modern technology (e.g., spiral CT, EUS, FDG-PET), clinical staging remains suboptimal. These shortcomings in staging, as well as in different attitudes toward extent of resection and lymphadenectomy, are reflected by a great variation in surgical techniques, which are discussed in this review...

INTRODUCTION: Although two large prospective and randomized planned European studies failed to show any benefit of radical D2 lymphadenectomy for gastric cancer, the value of radical lymphadenectomy is still a matter of controversy. METHODS: A radical surgical approach principally using D2, D3 lymphadenectomy, as defined by the Japanese Research Society for Gastric Cancer, has been prospectively performed since January 1984. Out of 729 patients with gastric cancer, 521 were surgically treated for potential cure between 1984 and 31 December, 1998...

This study reports interim data on post-operative morbidity, hospital mortality and duration of hospital stay of Italian patients undergoing extended lymph-node dissection combined with a pancreas-preserving technique for gastric cancer. Of the 218 patients admitted to one of eight general and/or university hospitals in North Italy, 118 were enrolled in the trial. Eligible patients presented with proven primary adenocarcinoma of the stomach without clinical evidence of distant, peritoneal and/or liver metastasis, or metastasis in para-aortic and retropancreatic nodes at intraoperative biopsy...